Putting together the health effects of nicotine and the chemical components of regular commercial e-cigarette inhalants leads to a conclusion that the risk is small but not trivial. Given that we need a long-term assessment, yet have only short-term experience, the harm could prove worse than it appears so far. One way to appreciate the magnitude is to compare vaping to current smokers and never smokers. The consensus that Gen Re and Johns Hopkins University (JHU) experts reached is that vaping risk falls much closer to never smokers than current smokers. This pertains only to users of regular commercial products. Home-brew and informal inhalants cause EVALI (e-cigarette or vaping use-associated lung injury) and carry clearly unacceptable risks.

This assessment leads to an active controversy in health policy: While advocacy of vaping as a replacement for smoking should yield harm reduction, will adoption of vaping by nonsmokers negate or oven outweigh the aggregate population health result? The most compelling concern revolves around the propensity for people of school age who would otherwise remain nonsmokers to adopt e-cigarettes. The myriad flavors have demonstrated so much appeal to this group that legislators in the U.S. Congress and the states have restricted them. The argument for benefit is that smoking tobacco is so clearly more dangerous than almost any other substance use.

The intermediate risk of vaping could support a risk class intermediate between smoker and nonsmoker. With modifications to our typical insurance application, it is feasible to add the category of vaping to the typical smoker/nonsmoker classification. Assignment of a concrete risk price to this concept is complicated. The price will have to support a degree of misrepresentation by tobacco smokers that could be substantial.

We reviewed insurance applications from numerous U.S. carriers. All of them ask detailed questions for the amount and type of tobacco product consumption. None inquire about e-cigarette use. The addition of a question on vaping absolutely requires further inquiry into the nature of the inhalant, especially TCH, Vitamin E, and non-commercial products in order to assess EVALI risk.

Differentiation is impossible between vaping with nicotine and smoking, even with full fluid-based underwriting. The underwriter must depend on self-report. Fluidless accelerated underwriting compounds the problem, making any form of nicotine use indistinguishable from nonsmoking except by self-report.

Group Life experience will reflect the same dynamic as population health. To the extent that smokers transition to vaping, mortality will improve. Ex-smokers and nonsmokers who take up e-cigarettes will offset their effect.

Our collaboration with JHU deepened our expertise on vaping. Part 1 of this blog series described the large and growing extent of vaping throughout the world. Part 2 reviewed some of the likely health effects of vaping. We have tackled other topics with them as well. Stay tuned for our thoughts on ehrlichiosis (the bacterial illness transmitted by ticks) and physical activity.